Richard B the EMT

Are Zombies picky eaters, that they cannot eat a dead person's brains? They have to do CPR to keep open their food supply? Still funny. On a different Zombie "take", try this non EMS related video... http://www.youtube.com/watch?v=DEyGbcBIigs

Sounds like a kind of trade-off.

Mean Mike was bitten by a black mamba snake. It was horrible, watching the snake curl up and die.

Think of the poor tech/medic has to take the BPs of, first, Hulk Hogan, then Peter Dinklage. Services should supply the ambulances with a wide assortment of cuff sizes, for both manual and automatic BP units.

I admit that DoccRobb and my postings of positioning at a HazMat is not cookie cutter in nature. Train tank cars are a way different category than, say, a double-bottom tanker trailer (2 or more trailers pulled by one truck)

When a CFR-D (Certified First Responder-Defibrillator) FDNY Engine Company crew-person takes a BP, I ask them for their reading, but explain I'll be taking my own, as will the Paramedics behind me, and the ER staff after them, and that's per policy. That way, I hope they don't think I don't trust them in getting a BP reading. (No jokes on the FFs please) FYI, I don't think that the FDNY CFR-Ds, EMT-Bs or Paramedics are using automated BP units in the field, yet.

Bubba is waiting, as (s)he hates anything that hurts kids.

OK, has the Paramedic in question gone before either an agency or state DoH review board to attempt defending the questioned actions? If not, do either the agency or state run such review boards? Does either the agency or state allow individual case by case review re these type circumstances, to determine if, after some form of training remedial, the Paramedic can re-apply for the Paramedic position?

What I'm referencing, is some of our members are almost autonomous, not needing either OLMC or a Dr, until and unless they feel a patient needs to "Get to da choppah". Those would be Paramedics serving in wilderness encampments, as one example, mid ocean oil rigs as a possible other. (Forgive the "Governator" reference, I just couldn't resist.)

That's a story with many points, and just buzzes along.

As one who learned long ago, not to discuss Politics or Religion with friends, or they won't be your friends for too much longer, I'm scared to bring this sort of commentary, but... Per my understanding, Agnostics believe in God, but not in any organized religion to worship God. Atheists, on the other hand, don't believe in God, period. If I just rephrased something someone else has already posted, I apologize. (Just as a reminder, in the event of a Nuclear War Attack, the laws about praying in Public Schools will be temporarily suspended)

I do hope all in this discussion remember that local, county or parish, state or province, and country protocols may be totally different, as I note both US and Canadian string contributors. There will probably also be similarities, too.

Mike, would you agree with my assessment, oft repeated, that anyone in any aspect of the emergency services (LEO, Fire Fighter, EMT/Paramedic), after a year on the job, just describing what we do, in our various capacities, in book form, first person, the general public would still be saying, "No way that could happen, the way described"?

Per the newspaper article... After so blatently operating outside of scope, knowing he was going out of scope, and admonished by others on his level of scope on the scene not to do it, I'm surprised he wasn't bounced after the Vermont DoH reviewed his actions, let alone wait until he attempted to renew his license/certification. What I didn't see in the article was if he was attempting to treat under On Line Medical Control's direct advisement. I admit I don't know where or when it happened, but 2 Paramedics, operating out of scope, but under directions from their OLMC, literally step by step, performed a Cesarean delivery of a viable fetus from it's deceased mother. Those 2 initially were suspended, but the OLMC Doctor went on record at the DoH hearing, indicating he trusted the 2 Paramedics to exactly follow his instructions, resulting in the successful delivery and saving of the baby's life (Unknown what the result would have been if the baby had NOT survived, for either the Paramedics or the Doctor).

The only physics that I use, and part of the reason for the existance of the EMT City, is that two objects cannot occupy the same space at the same time. Vehicle drivers at intersections continually try to disprove that!

Right click and open in new tab worked.

Clicked one time, and they'd still collapse in a second before I could read them

Hey! Carfeful, guys, or we'll end up scaring RuralKSEMS off of the city!

I'd open them, and they'd collapse in a second before I could read them.Admittedly not knowing how to do this sort of thing, perhaps the GIFs may be better?

I'm not in the "Pilot" area. Unknown if it will be extended, as a Pilot, to the NYC FDNY EMS,and other ambulances under NYC 9-1-1 control.

Seems we've had numerous discussions on the use of Naloxone, not yet widely used in the NY Area. I just got this in, and am passing it along. To: All Emergency Medical Services (EMS) Agencies From: Nassau REMAC RE: BLS Naloxone Administration Pilot Program Date: September 17, 2012 On behalf of the Regional Council, we would like to thank you for your interest in the Basic Life Support (BLS) Naloxone Administration program. Based upon the success of agencies in other states, The AIDS Institute - New York State Department of Health has approved this initiative for a selective pilot program. The goal of this program is to provide faster appropriate care to Opioid Overdose patients in our region. This information packet will help your agency apply for participation in this program. Details of all requirements are enclosed. Please call (516) 542-0025 if you have any questions. Thank you for your time and interest in the BLS Naloxone Administration Pilot Program. NASSAU REGIONAL EMERGENCY MEDICAL ADVISORY COMMITTEE 2201 Hempstead Turnpike, Bin 78 East Meadow, NY 11554-1859 Phone: 516-542-0025 FAX: 516-542-0049 Website: www.nassauems.org BLS Naloxone Administration Pilot Program 2012 Table of Contents Checklist for completion of BLS Naloxone Administration Program requirements Agency Letter of Intent Required Agency Information Sheet Medical Advisor Statement of Agreement Required equipment list for a Intranasal Naloxone Administration Program Suspected Opioid Overdose Protocol for BLS Providers AAREMS, Monroe Livingston, Mountain Lakes, REMO and Suffolk BLS Administration of Naloxone to Reverse Opioid Overdose Frequently Asked Questions BLS Naloxone Administration Pilot Program 2012 Application Checklist All BLS Agencies: ____ Signed Letter of Intent ____ Required Agency Information Sheet ____ Signed Statement of Agreement from Medical Director BLS Naloxone Administration Pilot Program 2012 Agency Letter of Intent for Participation in the BLS Naloxone Administration Pilot Program We the members of __________________________________, hereby request ( name of agency) permission to participate in the REMO BLS Naloxone Administration Program. We agree to abide by the following : All necessary equipment and IN Naloxone trained personnel will be provided on a twenty-four (24) hour per day, seven (7) days a week schedule. 2. All providers will complete the Naloxone Administration Training Material and complete the Pre & Post Survey. All survey materials are to be returned to REMO. 3. Our agency is regionally certified at the EMT-D level. All agency and personnel must follow all policies, procedures and protocols set forth by the Regional Medical Advisory Committee and NY State. 5. Our agency will provide and document annual BLS Naloxone updates with competency skill testing for all active providers. Our agency agrees to participate in the Regional Quality Improvement Program. All calls in which IN Naloxone are administered must be reviewed by the agency Medical Advisor. A copy of the PCR must be sent to REMAC within 24 hours. If our agency, or one of our personnel disregards these guidelines and/or other applicable protocols, the privilege of providing pre-hospital Naloxone treatment may be revoked or suspended by the REMAC. Any changes to the Required Agency Information will be reported to REMAC within 30 business days. The signatures below certify that the above conditions will be maintained and that we will be responsible for all aspects of participation in this Regional program. _____________________________ _____________________________ Agency Captain/President Agency Medical Advisor BLS Naloxone Administration Pilot Program 2012 Required Agency Information (please print) Agency Name: _________________________________ Agency Phone Number: __________________ Agency Mailing Address: _______________________________ City: ____________ Zip___________ Designated representative responsible for the BLS Naloxone Administration Pilot Program: Name: ____________________________ Daytime #: ____________________________ Email (if applicable): ____________________________ Agency Administrator (Captain or President): Name: ____________________________ Daytime #: ____________________________ Email (if applicable): ____________________________ Agency Medical Advisor: Name: ____________________________ Daytime #: ____________________________ Email (if applicable): ____________________________ Agency QI Coordinator: Name: ____________________________ Daytime #: __________________ Email (if applicable):__________________ We will receive Overdose Prevention Rescue Kitsfrom: �� AAREMS �� Monroe Livingston �� Mountain Lakes �� REMO �� Suffolk �� Nassau Naloxone will be stored in the Agency's station in the following manner: ___________________________________________________________________________________ ___________________________________________________________________________________ 7. Naloxone will be carried and secured on the ambulance(s) in the following manner: ___________________________________________________________________________________ ___________________________________________________________________________________ The following ALS agencies will be called for intercepts: ___________________________________________________________________________________ ___________________________________________________________________________________ Must Be Completed By BLS Non-transporting Agencies ONLY: 9. Primary transporting ambulance service: Name: _______________________________________________ BLS Naloxone Administration Pilot Program 2012 Medical Director Statement of Agreement I hereby agree to serve as the Medical Director for: ______________________________________________________________________. ( name of agency) I understand that all patient care will be provided under my license, in accordance with NYS and REMAC regional protocols and training guidelines, except in cases of gross negligence resulting in injury or death. Upon signing this document, I agree to : Provide and/or assist with annual Naloxone in-services/updates and training Annually renew the Naloxone agreement with this agency Participate in Q.I., and review all calls in which Naloxone was administered and any other calls as necessary Provide medical leadership Act as a resource for continuing education Remain familiar with regional and NY State BLS protocols If I have any questions concerning my responsibilities, I will contact REMAC. MD signature: _________________________________________________ MD name printed: ______________________________________________ Date: ____________ MD daytime phone #: _________________________ MD address: ___________________________________________________ ___________________________________________________ BLS Naloxone Administration Pilot Program 2012 Equipment List The following minimum equipment should be carried on every BLS unit: 2 - Overdose Prevention Rescue Kits Contents: 1- Intranasal Mucosal Atomization Device 1- Pair of gloves 1- Prefilled syringe with: Naloxone Hydrochloride Inj., USP 2mg per 2ml 1- Rescue Breathing Face Shield 2- Alcohol Prep Kits 1- Administration Use Form BLS Naloxone Administration Pilot Program 2012 Suspected Opioid Overdose Protocol for BLS Providers AAREMS, Monroe Livingston, Mountain Lakes, REMO, Suffolk and Nassau Patient must have suspected narcotic overdose AND respiratory depression. Naloxone is not given to rule out opiate use. I. Perform initial assessment. If ventilatory status is inadequate (patient is cyanotic, altered mental status, respiratory rate less than 10) support respirations according to Respiratory/Arrest Failure protocol. II. Check blood glucose (BG must be greater than 65) III. Determine potential for narcotic overdose (at least one of the following) a. History of overdose from bystanders b. Paraphernalia consistent with opiate/narcotic use c. Medical history consistent with opiate/narcotic use d. Respiratory depression with pinpoint pupils IF I, II and III are true THEN proceed with NALOXONE as follows: IV. Open sealed NALOXONE container and remove one unit dose of Naloxone a. Examine for appropriate labeling, expiration and appearance b. Attach mucosal atomizer device (MAD) to the syringe V. Insert MAD into LEFT nostril and inject HALF the medication Repeat into the RIGHT nostril VI. Continue to support ventilation as appropriate while initiating transport to closest appropriate Facility VII. Document vital signs every 5 minutes VIII. If patient's respiratory rate does not increase to greater than 10 within 10 minutes of initial Naloxone administration, repeat with second unit dose of Naloxone Relative Exclusion Criteria: (Medical Control Option)  Cardiopulmonary Arrest  Recent seizure activity either by report or signs of recent seizure activity (oral trauma, urinary incontinence)  Pediatric patients  Opiate use for therapeutic purposes prescribed by a physician  Evidence of nasal trauma, nasal obstruction and/or epistaxisBLS Naloxone Administration Pilot Program 2012 BLS Administration of Naloxone to Reverse Opioid Overdose Frequently Asked Questions 1. What is the reporting or follow-up process after we administer the medication? After you give a dose of the Naloxone please complete the brief data form that is included with each blue packet. Your agency must restock the medication at the Regional Program Agency. This medication will not be restocked at the hospital. When the Naloxone is restocked, they will collect a copy of the PCR for the patient for follow up. 2. Can you use Naloxone if you don’t know what the person took? Yes but you should be pointed towards the fact that it’s an opiate. Some thing should give you the information that the person has an overdose that you will be able to reverse. Pin point pupils in an unknown overdose with out breathing or with very little breathing. That would be the sign that it would likely be an opioid overdose and someone should use the Naloxone on them. 3. Will Naloxone work for someone that is pulseless and that isn’t breathing? An opioid overdose can cause someone to go into a cardiac arrest, but if the heart is not beating medication in their nose isn’t going to be circulated through their body and it’s not going to help. It’s something that might be used by paramedics or critical care techs as part of their resuscitation for the patient but won’t help initially until they regain spontaneous circulation. 4. How much time after the overdose do you have to administer the Naloxone? It will not work on cardiac arrest but any patient not breathing well will benefit from the Naloxone if they took an opiate and that’s the reason so those are the patients we are going to give it to. They don’t have to be breathing at all for the medicine to work because where it’s absorbed is on the mucosal surface on the inside of the nose. It’s not absorbed in the lungs with them breathing it in and out. 5. Are there any situations where there may be difficulty with administration or uptake of the medication? Generally, there are very few problems with administering the medication or uptake of the medication by the nasal mucosa. Here are some possible problems to be aware of: Drugs like cocaine which are vasoconstrictors can prevent absorption. Bloody nose, nasal congestion, mucous discharge – will decrease effectiveness of nasal medication Lack of nasal mucosa as a result of surgery, injury or cocaine abuse may also decrease absorption through nose. If given more medication than 1 ml or more per nostril, it’s likely to run off. 6. Does it matter if a person overdosed on a prescription drug as opposed to a street drug such as Heroin? It doesn’t. Both prescription and non ‐prescription opiate medications will be reversed by Naloxone. Some of these medications will require more Naloxone than others but it will work. Common street drugs like Heroin will be reversed by this. Common prescription medications like MS Contin, Vicodin, Lortab, Percocet, Oxycodone, and other opioid medications will be reversed by Naloxone as well. 7. Can we use this medication to determine what they did take? If somebody is altered, don’t give them this medicine. If they are hypo ‐ventilatory, and not breathing well enough, then they can get the Naloxone. Nalooxone is not for trying to figure out what they took but trying to start them breathing by reversing the opioid they have on board. 8. Would this work on somebody who’s consumed a Fentanyl Patch? Absolutely. It will work on someone that took Fentanyl or took a Fentanyl Patch. The Fentanyl Patches have an incredible amount of medication in them. It’s a long acting medication that is designed for application over 3 days. If someone consumes a Fentanyl Patch, they may have a little bit of resolution BLS Naloxone Administration Pilot Program 2012 with their symptoms with their initial dose of Naloxone, but they may need more. So it’s definitely a patient who if you have the ability to get more Naloxone to the scene, into the patient or meet other crews enroute to the hospital who can give you more Naloxone, it’s definitely a patient who needs it. 9. What if we give the Naloxone to someone who doesn’t need it? If there isn’t an opioid on board for that patient, there will be no effect from the Naloxone. 10. Can you give the medication is the patient is seizing? If the patient is actively seizing it is unlikely that they will be overdosing on an opioid medication. However, if they are not breathing and they begin to tremor, it may be because of hypoxia. If there are any questions, contact a medical control physician. 11. Do you have to call a doctor before administering the medication? No. With this project, there is a standing order that allows EMT ‐B to administer the medication. 12. How long before administering another dose? If there is no response, or limited response, you may give another dose in 10 minutes. 13. Can the medication be applied sublingually if there is no access to the nose due to injury or other issue? No. The nature of the lining of the mouth is different than the nasal mucosa. Naloxone must be administered via the nose. 14. Is the medication temperature sensitive? Yes, but not terribly so. This medication can be safely stored with your Epipen. 15. Is there CME credit available for this training program? Yes, 1.5 CME Credits are available for the completion of training. Training course rosters should be submitted to REMO and CME Certificates shall be issued.

Lucky, no deaths. Looked like the videographer damn near got hit with debris flying from that blast. Did the person who set this episode up lose their job? Should have.

We can only hope the intended kidney recipient didn't follow the kidney "down the hopper".

So you're from Yonkers, NY? LOL. Really, welcome aboard.

Matrix Consulting Group probably never heard of multi alarm fires. Well then, where are temporary light duty personnel to be assigned while they recover? Or if they're not dying but can hobble back and forth, put them back on their apparatus, and risk the lives and health of the others on that apparatus.